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General NPI Number Information
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NPI Number | 1164306064
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Entity Type | Individual
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Provider Name | RIKKI LARAY GLEZEN FNP-C
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Gender | Female
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Dates
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Enumeration Date | 08/04/2025
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 2901 4TH ST
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City | LONGVIEW
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State | TX
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Zip | 75605-5128
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Country | US
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Telephone | 903-758-1818
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Fax |
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Provider Business Mailing Address
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Address Line | 1121 E HAWKINS PKWY APT 3113
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City | LONGVIEW
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State | TX
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Zip | 75605-0117
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Country | US
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Telephone | 903-475-2093
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1206446
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License Number State | TX
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